Glucagon-Like Peptide-1 Receptor Agonist Treatment in Liver Cirrhosis
Authors: Cheng Han NG, Pojsakorn Danpanichkul, Mark Muthiah
Journal: Clinical Gastroenterology and Hepatology (2023)

The relationship between cirrhosis and type 2 diabetes (T2D) presents significant health challenges. T2D increases the risk of cirrhosis and worsens its outcomes. Glucagon-like peptide-1 receptor agonist (GLP-1 RA), used primarily for diabetes, has shown promise in treating liver issues, with studies of semaglutide improving metabolically associated steatohepatitis (MASH) outcomes compared with placebo.1Muzica C.M. et al.Can J Gastroenterol Hepatol. 2020; 20206638306Crossref Scopus (46) Google Scholar,2Newsome P.N. et al.N Engl J Med. 2021; 384: 1113-1124Crossref PubMed Scopus (734) Google Scholar Despite these promising findings, the extent of GLP-1 RA's effects, particularly in patients afflicted with cirrhosis and T2D, remains relatively unexplored. A compelling study by Yen et al3Yen F.S. et al.Clin Gastroenterol Hepatol. 2023; https://doi.org/10.1016/j.cgh.2023.06.004Abstract Full Text Full Text PDF Scopus (6) Google Scholar assessed GLP-1 RA's benefits for these patients. Through propensity score matching of 467 subjects and additional treatment weight adjustments, the study found that GLP-1 RA possibly decreases decompensation, mortality, cardiovascular events, and liver failure. This study significantly adds to the existing literature by providing real-world evidence of the beneficial effects of GLP-1 RA in reducing hard objective outcomes among patients with liver cirrhosis. This study, however, was not without limitations. Notably, 30% of the cirrhosis cases studied were hepatitis B, raising questions about the broader application for other etiologies. A recent trial on MASH cirrhosis did not significantly reduce fibrosis and MASH compared with a placebo. In addition, the failure of GLP-1 RA in patients with type 2 diabetes mellitus owing to poor β cell function might decrease long-term efficacy. Nonetheless, this research is crucial in understanding T2D with liver cirrhosis management. It prompts further studies to verify these findings, delves into GLP-1 RA's mechanisms, and necessitates larger-scale randomized controlled trials for validation. Glucagon-like Peptide-1 Receptor Agonist Use in Patients With Liver Cirrhosis and Type 2 DiabetesClinical Gastroenterology and HepatologyPreviewLiver cirrhosis is often associated with type 2 diabetes (T2D), but research on treatment of T2D in cirrhotic patients is scarce. We investigated the long-term outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with T2D and cirrhosis. Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 22Issue 4PreviewWe are grateful to Cheng Han Ng1 for carefully reading our article and providing valuable comments.2 We also agree that there is a significant interrelationship between diabetes and liver cirrhosis. Asia has one of the highest burdens of diabetes mellitus and liver cirrhosis in the world.3,4 Moreover, patients with liver cirrhosis, as a result of substantial liver damage, have altered drug metabolism and excretion, making the treatment of diabetes in cirrhotic patients more complex.1 This is why we have dedicated much of our time in recent years to performing diabetes treatment–related research for patients with liver cirrhosis. Full-Text PDF